Annelotte van Bommel

36 Future directions of the audit A future challenge is the development of more robust and reproducible quality indicators for all disciplines involved in the treatment of patients with breast cancer. At themoment, the NBCA has a data verification process to achieve reliable hospital comparisons. In the near future, more extensive data verification will be done in order to secure the quality of the data. For indicators without norms, reasons for the observed variation should be addressed by evaluating the audit data and further in-depth research. The availability of these data enables us not only to investigate and understand the variation found, but also to inspect hospitals on their performances and learn from best practices to further improve quality of breast cancer care for each hospital, throughout the country. Furthermore, a balance is required between capturing all valuable information on the one hand and spending an acceptable amount of time needed for data entry on the other hand. At the moment, the 32 current quality indicators are calculated based on 75 registered items. Developing new quality indicators of interest should be accompanied by deleting indicators that have become redundant. Amodest and acceptable investment of time (and finances) is one of the major challenges for the NBCA. Various ways to reduce the registration burden are explored. Lastly, since patient-centered care is becoming more and more focused on the perceived quality of care, the NBCAwill start measuring patient-reported outcome measures (PROMs) in order to evaluate the patient’s outcomes with the care delivered, also on a longer term. PROMs will be implemented in 2016 and the dataset will be aligned with other initiatives focusing on patient-centered care such as the International Consortium for Health Outcomes Measurement (ICHOM). 19 This leads to an increased number of outcome indicators along with the process indicators and opportunities for international comparisons. The outcome indicators for recurrent disease will become available after 5 years.